Displaying publications 1 - 20 of 32 in total

  1. Sreeramareddy CT, Qin ZZ, Satyanarayana S, Subbaraman R, Pai M
    Int J Tuberc Lung Dis, 2014 Mar;18(3):255-66.
    PMID: 24670558 DOI: 10.5588/ijtld.13.0585
    OBJECTIVE: To systematically review Indian literature on delays in tuberculosis (TB) diagnosis and treatment.
    METHODS: We searched multiple sources for studies on delays in patients with pulmonary TB and those with chest symptoms. Studies were included if numeric data on any delay were reported. Patient delay was defined as the interval between onset of symptoms and the patient's first contact with a health care provider. Diagnostic delay was defined as the interval between the first consultation with a health care provider and diagnosis. Treatment delay was defined as the interval between diagnosis and initiation of anti-tuberculosis treatment. Total delay was defined as time interval from the onset of symptoms until treatment initiation.
    RESULTS: Among 541 potential citations identified, 23 studies met the inclusion criteria. Included studies used a variety of definitions for onset of symptoms and delays. Median estimates of patient, diagnostic and treatment delay were respectively 18.4 (IQR 14.3-27.0), 31.0 (IQR 24.5-35.4) and 2.5 days (IQR 1.9-3.6) for patients with TB and those with chest symptoms combined. The median total delay was 55.3 days (IQR 46.5-61.5). About 48% of all patients first consulted private providers; an average of 2.7 health care providers were consulted before diagnosis. Number and type of provider first consulted were the most important risk factors for delay.
    CONCLUSIONS: These findings underscore the need to develop novel strategies for reducing patient and diagnostic delays and engaging first-contact health care providers.
  2. Abidin NZ, Zulkifli A, Abidin EZ, Rasdi I, Ismail SN, Rahman AA, et al.
    Int J Tuberc Lung Dis, 2014 Jul;18(7):856-61.
    PMID: 24902566 DOI: 10.5588/ijtld.13.0906
    OBJECTIVE: To identify the relationship between knowledge, attitude and perception regarding environmental tobacco smoke (ETS) and smoking among Malaysian adolescents living in states with complete or partial smoke-free legislation (SFL).
    METHODS: A total of 898 respondents aged 13-14 years were randomly selected from 21 secondary schools. The Malay version of the modified Global Youth Tobacco Survey questionnaire was used. Hierarchical logistic regression was performed in examining predictors of smoking attempt among adolescents.
    RESULTS: Participants exposed to ETS >5 h/day were more likely to have smoked compared to those exposed to ETS <1 h/day (OR 4.1, 95%CI 1.03-16.0). Living in a state with partial SFL was associated with a two-fold increase in self-reported smoking attempts (OR 1.95, 95%CI 1.10-3.43) compared to living in a state with complete SFL. Negative attitudes and perceptions towards smoking and ETS exposure were linked to lower smoking attempts in states with complete SFL.
    CONCLUSIONS: Adolescents with limited ETS exposure who lived in a state with complete SFL were less likely to attempt smoking compared to those exposed more regularly to ETS and living in a state with partial SFL. Preventing adolescents from becoming smokers is the key to reducing national prevalence rates in smoking. There is a need to implement comprehensive smoke-free legislation nationally across Malaysia.
  3. Tee GH, Gurpreet K, Hairi NN, Zarihah Z, Fadzilah K
    Int J Tuberc Lung Dis, 2013 Dec;17(12):1652-5.
    PMID: 24200284 DOI: 10.5588/ijtld.12.0241
    Assistant environmental health officers (AEHO) are health care providers (HCPs) who act as enforcers, educators and trusted role models for the public. This is the first study to explore smoking behaviour and attitudes toward tobacco control among future HCPs. Almost 30% of AEHO trainees did not know the role of AEHOs in counselling smokers to stop smoking, but 91% agreed they should not smoke before advising others not to do so. The majority agreed that tobacco control regulations may be used as a means of reducing the prevalence of smoking. Future AEHOs had positive attitudes toward tobacco regulations but lacked understanding of their responsibility in tobacco control measures.
  4. Margolis B, Al-Darraji HA, Wickersham JA, Kamarulzaman A, Altice FL
    Int J Tuberc Lung Dis, 2013 Dec;17(12):1538-44.
    PMID: 24200265 DOI: 10.5588/ijtld.13.0193
    There are currently no routine screening procedures for active tuberculosis (TB) or latent tuberculous infection (LTBI) in Malaysian prisons.
  5. Tee GH, Hairi NN, Hairi F
    Int J Tuberc Lung Dis, 2012 Aug;16(8):1126-8.
    PMID: 22668450 DOI: 10.5588/ijtld.11.0254
    Physicians should play a leading role in combatting smoking; information on attitudes of future physicians towards tobacco control measures in a middle-income developing country is limited. Of 310 future physicians surveyed in a medical school in Malaysia, 50% disagreed that it was a doctor's duty to advise smokers to stop smoking; 76.8% agreed that physicians should not smoke before advising others not to smoke; and 75% agreed to the ideas of restricting the sale of cigarettes to minors, making all public places smoke-free and banning advertising of tobacco-related merchandise. Future physicians had positive attitudes towards tobacco regulations but had not grasped their responsibilities in tobacco control measures.
  6. Yasin SM, Moy FM, Retneswari M, Isahak M, Koh D
    Int J Tuberc Lung Dis, 2012 Jul;16(7):980-5.
    PMID: 22507850 DOI: 10.5588/ijtld.11.0748
    Many smokers attempt to quit smoking, but very few succeed.
  7. Al-Darraji HA, Kamarulzaman A, Altice FL
    Int J Tuberc Lung Dis, 2012 Jul;16(7):871-9.
    PMID: 22410101 DOI: 10.5588/ijtld.11.0447
    Tuberculosis (TB) remains a major cause of morbidity and mortality worldwide and the main cause of death in correctional facilities in middle- and low-income countries. Due to the closed environment and the concentration of individuals with TB-related risk factors, effective measures are required to control TB in such settings. Isoniazid preventive therapy (IPT) represents an effective and cost-effective measure. Despite international recommendations that IPT be integral to TB control, it is seldom deployed. A systematic review of interventions used to assess IPT initiation and completion in correctional facilities was conducted using published studies from two biomedical databases and relevant keywords. Additional references were reviewed, resulting in 18 eligible studies. Most (72%) studies were conducted in the United States and in jail settings (60%), with the main objective of improving completion rates inside the facility or after release. Studies that provided data about initiation and completion rates showed poor success in correctional facilities. Adverse consequences and treatment interruption ranged from 1% to 55% (median 5%) in reported studies; hepatotoxicity was the most prevalent adverse reaction. Despite its accelerating effect on the development of active TB, information on human immunodeficiency virus (HIV) status was provided in only half of the studies. Among the four studies where IPT effectiveness was assessed, the results mirror those described in community settings. Future studies require thorough assessments of IPT initiation and completion rates and adverse effects, particularly in low- and middle-income countries and where comorbid viral hepatitis may contribute significantly to outcomes, and in settings where TB and HIV are more endemic.
  8. Rundi C, Fielding K, Godfrey-Faussett P, Rodrigues LC, Mangtani P
    Int J Tuberc Lung Dis, 2011 Sep;15(9):1231-8, i.
    PMID: 21943851 DOI: 10.5588/ijtld.10.0585
    SETTING: The state of Sabah contributes one third of the tuberculosis (TB) cases in Malaysia.

    OBJECTIVE: To collect information on factors that affect the time period from the onset of symptoms to first contact with health care providers, whether private or government.

    DESIGN: A cross-sectional study using a pre-tested questionnaire was conducted among 296 newly registered smear-positive TB patients in 10 districts in Sabah. Univariable and multivariable analyses were used to determine which risk factors were associated with patient delay (>30 days) and 'extreme' patient delay (>90 days).

    RESULTS: The percentage of patients who sought treatment after 30 and 90 days was respectively 51.8% (95%CI 45.7-57.9) and 23.5% (95%CI 18.6-29.0). The strongest factors associated with patient delay and 'extreme' patient delay was when the first choice for treatment was a non-government health facility and in 30-39-year-olds. 'Extreme' patient delay was also weakly associated, among other factors, with comorbidity and livestock ownership.

    CONCLUSION: Delay and extreme delay in seeking treatment were more common when the usual first treatment choice was a non-government health facility. Continuous health education on TB aimed at raising awareness and correcting misconceptions is needed, particularly among those who use non-government facilities.

  9. Rafiza S, Rampal KG
    Int J Tuberc Lung Dis, 2012 Feb;16(2):163-8.
    PMID: 22236915 DOI: 10.5588/ijtld.11.0364
    BACKGROUND: Serial testing for tuberculosis (TB) exposure has been advocated among health care workers (HCWs) at risk of nosocomial infection.
    OBJECTIVE: To determine the incidence and factors associated with TB infection among selected HCWs in Malaysia and to determine interferon-gamma response in serial testing.
    DESIGN: A cohort of 769 HCWs were retested after 1 year using QuantiFERON®-TB Gold In-Tube. Incidence of TB infection was determined among HCWs who previously tested negative. Conversion and reversion rates using several definitions were explored.
    RESULTS: Incidence of TB infection was 9.9 per 100 workers per year (95%CI 7.9-12.3). Working in the Emergency Department (ED; RR 2.18, 95%CI 1.07-4.43) was significantly associated with risk of TB infection. Reversion and conversion occurred frequently, with 46.7% reversion among HCWs with baseline interferon-gamma (IFN-γ) levels of 0.35-0.70 international units (IU)/ml, and 23.8% conversion among HCWs with baseline IFN-γ levels of 0.20-0.34 IU/ml.
    CONCLUSIONS: TB infection control measures need to be strengthened, particularly in the ED, as the incidence of TB was high. Conversion and reversion rates in serial testing were high, and further studies are needed to facilitate its interpretation.
  10. Ahmad N, Javaid A, Basit A, Afridi AK, Khan MA, Ahmad I, et al.
    Int J Tuberc Lung Dis, 2015 Sep;19(9):1109-14, i-ii.
    PMID: 26260834 DOI: 10.5588/ijtld.15.0167
    Although Pakistan has a high burden of multidrug-resistant tuberculosis (MDR-TB), little is known about the management and treatment outcomes of MDR-TB patients in Pakistan.
  11. Liew SM, Khoo EM, Ho BK, Lee YK, Mimi O, Fazlina MY, et al.
    Int J Tuberc Lung Dis, 2015 Jul;19(7):764-71.
    PMID: 26056099 DOI: 10.5588/ijtld.14.0767
    OBJECTIVES: To determine treatment outcomes and associated predictors of all patients registered in 2012 with the Malaysian National Tuberculosis (TB) Surveillance Registry.
    METHODS: Sociodemographic and clinical data were analysed. Unfavourable outcomes included treatment failure, transferred out and lost to follow-up, treatment defaulters, those not evaluated and all-cause mortality.
    RESULTS: In total, 21 582 patients were registered. The mean age was 42.36 ± 17.77 years, and 14.2% were non-Malaysians. The majority were new cases (93.6%). One fifth (21.5%) had unfavourable outcomes; of these, 46% died, 49% transferred out or defaulted and 1% failed treatment. Predictors of unfavourable outcomes were older age, male sex, foreign citizenship, lower education, no bacille Calmette-Guérin (BCG) vaccination scar, treatment in tertiary settings, smoking, previous anti-tuberculosis treatment, human immunodeficiency virus infection, not receiving directly observed treatment, advanced chest radiography findings, multidrug-resistant TB (MDR-TB) and extra-pulmonary TB. For all-cause mortality, predictors were similar except for rural dwelling and nationality (higher mortality among locals). Absence of BCG scar, previous treatment for TB and MDR-TB were not found to be predictors of all-cause mortality. Indigenous populations in East Malaysia had lower rates of unfavourable treatment outcomes.
    CONCLUSIONS: One fifth of TB patients had unfavourable outcomes. Intervention strategies should target those at increased risk of unfavourable outcomes and all-cause mortality.
  12. Liam CK, Lim KH, Wong CM, Tang BG
    Int J Tuberc Lung Dis, 1999 Apr;3(4):300-9.
    PMID: 10206500
    SETTING: An urban university teaching hospital.
    OBJECTIVES: To determine patients' attitudes to tuberculosis and their knowledge of the disease, and factors associated with treatment compliance.
    DESIGN: All adult patients commenced on treatment for tuberculosis from September 1994 to February 1996 were interviewed on initiation of treatment. To assess patient compliance with treatment, hospital clinical records were reviewed retrospectively.
    RESULTS: A total of 135 patients with a mean age (±SD) of 41.9 (±17.4) years (range 15–84 years) were interviewed. The patients had limited understanding and knowledge about tuberculosis. There was a negative correlation between patient age and tuberculosis knowledge score (r = −0.18, P = 0.038). Patients with tertiary education had better knowledge than the others. Of 118 patients who were followed-up in our chest clinic, 80 (67.8%) completed the prescribed treatment. Compliance with treatment and follow-up was not affected by age, sex, ethnic group, educational level, occupation, extent of knowledge, tuberculosis symptoms, hospitalisation for tuberculosis or duration of the prescribed treatment regimen. There was a trend toward poorer compliance among patients who equated disappearance of tuberculosis symptoms with cure of the disease.
    CONCLUSIONS: Malaysian patients with newly diagnosed tuberculosis attending a university teaching hospital had misconceptions and limited knowledge about the disease and its treatment. Educational background was an important determinant of a patient's level of knowledge about tuberculosis. Compliance was not affected by patient characteristics. Adequate counselling and education of patients and close relatives on tuberculosis and the necessity for prolonged treatment may help to improve treatment compliance.
    Study site: Chest clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
  13. O'Boyle SJ, Power JJ, Ibrahim MY, Watson JP
    Int J Tuberc Lung Dis, 2002 Apr;6(4):307-12.
    PMID: 11936739
    SETTING: Kota Kinabalu and surrounding communities in Sabah, Malaysia.
    OBJECTIVES: To establish factors affecting compliance of patients with anti-tuberculosis chemotherapy, their knowledge of the disease, and views on improving the DOTS strategy.
    DESIGN: Interviews with compliant patients attending clinics for DOTS treatment and with non-compliant patients in their homes, in August and September 2000.
    RESULTS: A total of 63 compliant and 23 non-compliant patients were interviewed. For non-compliant patients, reaching the treatment centre entailed greater cost (P < 0.005) and travel time (P < 0.005) compared to compliant patients. Cost of transport was the reason most frequently given for non-attendance. Non-compliant patients were more likely to have completed secondary education (P < 0.05), and to be working (P < 0.01). More non-compliant patients had family members who had had the disease (P < 0.01). There was no difference between the groups for overall tuberculosis knowledge scores; however, non-compliant patients were more likely to think that treatment could be stopped once they were symptom free (P < 0.01). Most patients (73%) felt that the DOTS system could be improved by provision of more information about tuberculosis.
    CONCLUSION: Compliance with DOTS in the Kota Kinabalu area is affected by travel expenses, time spent travelling to treatment centres, and having family members who have had the disease. Patients would like more information on tuberculosis.
    Study site: Tuberculosis clinics, Kota Kinabalu, Malaysia
  14. Liam CK, Lim KH, Srinivas P, Poi PJ
    Int J Tuberc Lung Dis, 1998 Oct;2(10):818-23.
    PMID: 9783529
    University Hospital, Kuala Lumpur, Malaysia.
  15. Liam CK, Lim KH
    Int J Tuberc Lung Dis, 1998 Aug;2(8):683-9.
    PMID: 9712285
    University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
  16. Lange B, Khan P, Kalmambetova G, Al-Darraji HA, Alland D, Antonenka U, et al.
    Int J Tuberc Lung Dis, 2017 05 01;21(5):493-502.
    PMID: 28399963 DOI: 10.5588/ijtld.16.0702
    SETTING: Xpert® MTB/RIF is the most widely used molecular assay for rapid diagnosis of tuberculosis (TB). The number of polymerase chain reaction cycles after which detectable product is generated (cycle threshold value, CT) correlates with the bacillary burden.OBJECTIVE To investigate the association between Xpert CT values and smear status through a systematic review and individual-level data meta-analysis.

    DESIGN: Studies on the association between CT values and smear status were included in a descriptive systematic review. Authors of studies including smear, culture and Xpert results were asked for individual-level data, and receiver operating characteristic curves were calculated.

    RESULTS: Of 918 citations, 10 were included in the descriptive systematic review. Fifteen data sets from studies potentially relevant for individual-level data meta-analysis provided individual-level data (7511 samples from 4447 patients); 1212 patients had positive Xpert results for at least one respiratory sample (1859 samples overall). ROC analysis revealed an area under the curve (AUC) of 0.85 (95%CI 0.82-0.87). Cut-off CT values of 27.7 and 31.8 yielded sensitivities of 85% (95%CI 83-87) and 95% (95%CI 94-96) and specificities of 67% (95%CI 66-77) and 35% (95%CI 30-41) for smear-positive samples.

    CONCLUSION: Xpert CT values and smear status were strongly associated. However, diagnostic accuracy at set cut-off CT values of 27.7 or 31.8 would not replace smear microscopy. How CT values compare with smear microscopy in predicting infectiousness remains to be seen.

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